The Remarkably Prescient
and Insightful Op-Ed in Today’s NY Times on Genomics and ‘Moonshot’ Medicine

By

Leonard Zwelling

         It was scary on target.

         Mayo Clinic anesthesiologist and physiologist Michael J.
Joyner has written a piece, and I kid you not, entitled ‘Moonshot’ Medicine
Will Let Us Down. He is absolutely correct in every way. Of course, that I have
been saying the exact same thing for 5 or more years does make be biased, but
his arguments are mine.

         First, precision medicine has been vastly oversold as the
best avenue to attack the remaining major causes of death among Americans,
heart disease, diabetes and cancer. He defines precision medicine as the study
of “genetic variants that put us at increased or decreased risk for various
diseases, or that make us more or less responsive to specific treatments.” I
would add that the same technology is being used to characterize malignancies
themselves with the same idea in mind—that of identifying the kind of car it
was that produced the pile of iron filings.

         Second, even identified genetic variants may not be
predictive of disease risk.

         Third, the same seems to be true of efforts to predict the
manner in which drugs will benefit or harm patients, so-called
pharmacogenomics.

         Fourth, he readily acknowledges that exceptions have been
found and on occasion genomics may prove of use.

         Fifth, he specifically singles out the problem of cancer
heterogeneity as a barrier to using sequencing to develop predictive signatures for designing the therapy of individual cancers.

         Sixth, he goes on to identify the risk of ill-examined and
imprecise assessments of risk to real patients. These imprecise assessments
have led to behaviors by both those told they have lower risk and those told they have higher risk that are inappropriate and inaccurate.

Finally,
he also identifies the code of silence among potential recipients of President
Obama’s new largess. These investigators want the money any way they can get
it. The funding situation at the NIH and NSF has become so precarious that even
considering a career in academic medicine is a high-risk endeavor regardless of
your genetic code.

He
concludes with this. “Like most “moonshot” medical research initiatives,
precision medicine is likely to fall short of expectations. Medical problems
and their underlying biology are not linear engineering exercises, and solving
them is more than a matter of vision, money and will.”

I
simply cannot say this any better. Bravo Dr. Joyner. I guess it takes an
anesthesiologist to wake us all up!  

The link is here but you may
need to be a subscriber to get to it. 
Sorry. I cannot cut and paste what is not mine.

Leonard Zwelling